Betters Kristina A, Hebbar Kiran B, McCracken Courtney, Heitz David, Sparacino Stephanie, Petrillo Toni
1Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 2Children's Healthcare of Atlanta, Atlanta, GA. 3Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA.
Pediatr Crit Care Med. 2017 Jul;18(7):e274-e280. doi: 10.1097/PCC.0000000000001181.
High-flow nasal cannula use in the PICU continues to increase; however, a protocol for weaning patients has yet to be published. This study aimed to create an efficient and safe protocol for weaning high-flow nasal cannula.
A Respiratory Assessment Score was created using two validated scoring systems. A protocol was established for set "holidays" off high-flow nasal cannula, where nasal cannula flow was reduced to age-based low-flow nasal cannula rates if Respiratory Assessment Scores met certain criteria.
The PICU at Children's Healthcare of Atlanta at Egleston, a quaternary level hospital affiliated with Emory University.
Patients treated in the PICU with high-flow nasal cannula from August 2013 to March 2014. Exclusions included apnea, heliox therapy, oxygen saturations less than 92% with a FIO2 greater than 50%, admitted to PICU less than 6 hours, progression to intubation prior to scoring, or those ordered by physician to not receive holidays based on clinical status.
Patients who qualified for a "holiday" based on Respiratory Assessment Score were trialed off high-flow nasal cannula and rescored afterwards to assess tolerance.
One hundred thirty-three patients were treated with high-flow nasal cannula, with the most common diagnosis being bronchiolitis (43%). Of these 133 patients, 119 (89.5%) successfully weaned to low-flow nasal cannula within four holiday attempts. Eighty-three patients (70%) weaned with only one attempt. Fourteen patients (10.5%) failed to wean. Reasons for failure were reintubation, increasing flow on high-flow nasal cannula, too high of Respiratory Assessment Score to meet weaning criteria, or slow weaning after failed attempts. Holidays did not precipitate clinical deterioration or lead to immediate intubation.
Our study suggests that a high-flow nasal cannula "holiday" protocol is a safe and effective way to successfully wean PICU patients off high-flow nasal cannula. Additional investigation including validation of the scoring system used is warranted.
儿科重症监护病房（PICU）中高流量鼻导管的使用持续增加；然而，尚未发布关于患者撤机的方案。本研究旨在创建一种高效且安全的高流量鼻导管撤机方案。
使用两个经过验证的评分系统创建了呼吸评估评分。制定了一项关于高流量鼻导管设定“停用期”的方案，如果呼吸评估评分符合特定标准，则将鼻导管流量降至基于年龄的低流量鼻导管速率。
埃默里大学附属的四级医院——亚特兰大儿童医疗保健中心埃格尔斯顿分院的PICU。
2013年8月至2014年3月在PICU接受高流量鼻导管治疗的患者。排除标准包括呼吸暂停、氦氧混合气治疗、在吸入氧分数（FIO2）大于50%时氧饱和度低于92%、入住PICU少于6小时、在评分前进展为插管，或医生根据临床状况下令不接受停用期的患者。
根据呼吸评估评分符合“停用期”条件的患者停用高流量鼻导管进行试验，之后重新评分以评估耐受性。
133例患者接受了高流量鼻导管治疗，最常见的诊断为细支气管炎（43%）。在这133例患者中，119例（89.5%）在四次停用期尝试内成功撤机至低流量鼻导管。83例患者（70%）仅一次尝试就成功撤机。14例患者（10.5%）撤机失败。失败原因包括再次插管、高流量鼻导管流量增加、呼吸评估评分过高不符合撤机标准，或尝试失败后撤机缓慢。停用期未引发临床恶化或导致立即插管。
我们的研究表明，高流量鼻导管“停用期”方案是使PICU患者成功撤机脱离高流量鼻导管的一种安全有效的方法。有必要进行包括对所使用评分系统进行验证在内的进一步研究。
